diff --git a/domains/health/mssp-acos-generate-record-savings-while-improving-quality-proving-cost-quality-cooptimization.md b/domains/health/mssp-acos-generate-record-savings-while-improving-quality-proving-cost-quality-cooptimization.md
index b0c747621..ee2999d2c 100644
--- a/domains/health/mssp-acos-generate-record-savings-while-improving-quality-proving-cost-quality-cooptimization.md
+++ b/domains/health/mssp-acos-generate-record-savings-while-improving-quality-proving-cost-quality-cooptimization.md
@@ -17,3 +17,10 @@ related: ["value-based care transitions stall at the payment boundary because 60
 # MSSP ACOs generated record $2.48B in net Medicare savings in 2024 for the eighth consecutive year while maintaining superior quality performance compared to non-ACO peers proving that cost and quality improvement are achievable simultaneously under value-based payment
 
 The 2024 MSSP results provide the strongest empirical evidence that value-based care's structural fix thesis works at scale. ACOs generated $2.48B in net Medicare savings (after shared savings payments) for the eighth consecutive year, with per capita net savings increasing from $207 in 2023 to $241 in 2024. Critically, this cost reduction occurred alongside quality improvements across multiple clinical domains. ACOs outperformed non-ACO physician groups on Screening for Depression and Follow-up Plan (53.53% vs 44.42%), Controlling High Blood Pressure (71.21% vs 67.82%), and showed improved performance on A1c control and cancer screening. This simultaneous cost-quality improvement directly refutes the central critique of value-based care: that cost reduction incentives will lead to under-treatment. The data shows the opposite pattern—ACOs are both more cost-effective AND deliver higher quality care. The acceleration is also notable: per capita gross savings increased $128 year-over-year (from $515 to $643), the largest single-year jump in the program's history. Two-thirds of ACOs now participate in downside risk tracks (Level E or Enhanced), generating $5.4B of the $6.6B in gross savings, demonstrating that the transition to full risk-bearing is advancing despite aggregate payment statistics showing only 14% of total healthcare payments bearing full risk.
+
+
+## Extending Evidence
+
+**Source:** Health Affairs 2024 MSSP analysis
+
+MSSP 2024 performance shows acceleration in per capita savings: $641 gross per capita (up $128 from 2023) and $241 net per capita (up $34 from 2023). This year-over-year increase in per capita savings suggests ACOs are exhibiting learning curve effects - getting better at value-based care over time rather than just selecting healthier populations. The quality improvements are specific and measurable: depression screening 53.5% vs 44.4% for non-ACO peers, blood pressure control 71.2% vs 67.8%, with cancer screening and A1c control also improving. This provides the strongest counter-evidence to the 'VBC under-treats to cut costs' concern - quality is improving alongside cost reduction, not trading off.
diff --git a/domains/health/mssp-downside-risk-adoption-accelerating-two-thirds-in-risk-tracks.md b/domains/health/mssp-downside-risk-adoption-accelerating-two-thirds-in-risk-tracks.md
index fe9706801..04b942129 100644
--- a/domains/health/mssp-downside-risk-adoption-accelerating-two-thirds-in-risk-tracks.md
+++ b/domains/health/mssp-downside-risk-adoption-accelerating-two-thirds-in-risk-tracks.md
@@ -16,3 +16,10 @@ related: ["value-based care transitions stall at the payment boundary because 60
 # Two-thirds of MSSP ACOs now participate in downside risk tracks generating more than two-thirds of all savings demonstrating that the transition to full risk-bearing is accelerating despite slow aggregate payment statistics
 
 The MSSP 2024 results reveal a critical structural shift in value-based care adoption that contradicts the narrative of stalled transition. Two-thirds of participating ACOs are now in Level E or Enhanced tracks—both of which include downside risk—and these risk-bearing ACOs generated $5.4B of the $6.6B in total gross savings (82% of all savings). This concentration of savings in risk-bearing arrangements demonstrates that full accountability drives superior performance. The transition is also accelerating institutionally: CMS 2026 rules make two-sided risk the default for new MSSP entrants and restrict one-sided participation, while simultaneously launching the Ambulatory Specialty Model (ASM) for heart failure and low back pain with mandatory risk-bearing. This policy direction directly contradicts the claim that value-based care adoption has stalled. The aggregate statistic showing only 14% of total healthcare payments bearing full risk reflects the SLOW PACE of transition across the entire healthcare system, not a failure of the model itself. Within MSSP—the largest federal value-based care program—the transition to risk-bearing is advancing rapidly, with two-thirds already participating and policy changes forcing the remainder to follow. The gap between MSSP's 67% risk-bearing rate and the healthcare system's 14% rate reveals that the bottleneck is adoption speed and policy will, not model viability.
+
+
+## Extending Evidence
+
+**Source:** Health Affairs 2024 MSSP analysis, CMS 2026 rules
+
+The two-thirds of ACOs now in Level E or Enhanced (downside risk) tracks generated $5.4B of the $6.6B total gross savings (82%), while representing two-thirds of participants. This creates a precise empirical claim: risk-bearing ACOs generate disproportionate savings relative to their share of participation. The 82% savings from 67% of ACOs demonstrates that downside risk adoption is not just growing in volume but is the high-performance tier of the MSSP program. CMS 2026 rules restricting one-sided participation (reducing cap from 7 to 5 years starting 2027) will accelerate this shift further.
diff --git a/inbox/queue/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md b/inbox/archive/health/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md
similarity index 97%
rename from inbox/queue/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md
rename to inbox/archive/health/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md
index 2138e03e8..7a4826a93 100644
--- a/inbox/queue/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md
+++ b/inbox/archive/health/2026-04-29-mssp-health-affairs-2024-aco-participation-trends.md
@@ -7,10 +7,13 @@ date: 2025-11-05
 domain: health
 secondary_domains: []
 format: article
-status: unprocessed
+status: processed
+processed_by: vida
+processed_date: 2026-04-29
 priority: medium
 tags: [ACO, MSSP, Medicare, value-based-care, policy, downside-risk, 2024]
 intake_tier: research-task
+extraction_model: "anthropic/claude-sonnet-4.5"
 ---
 
 ## Content